The patient came to the clinic 15-February-2011 complaining of neck pain with both shoulders more the left for more than 8 months with exacerbation of the pain in the left upper limb the last 3 months with numbness of the left hand.

On examination: The patient  has pain when turning the head to all directions with severe weak grip and extension left hand 3/5 and the left triceps 3/5.

The patient sent for MRI cervical spine, which was performed and showed PCD C5-6 with left foraminal occlusion and central small extrusion of C4-5.

Discectomy of C5-6 with removal of the extruded disc and osteophytectomy of the left posterior border of C5-6 was achieved and check for any pieces was performed. The dura was stuck with the elements of the posterior longitudinal ligament. It was not violated. Intradiscal decompression of C4-5. Fidji cage  12x15x4.5 mm with Novabone inserted to C4-5 and another cage 12x15x6.1 mm to the C5-6 space. Using Trinica plate 44 mm 2 level plate fusion of C4-5-6 was performed using 2 screws 14x4.2  at the C4 and 16x4.2 m at C5 and C6 bodies.

Routine closure of the wound. Smooth postoperative recovery with normalization of the power of left upper limb.

Surgery was indicated for the PCD C5-6 with foraminal occlusion, but the intradiscal decompression and fusion of C4-5 was performed to prevent future escalation at this level.